HENRY MOMANYI
NPI 1679207013
Nurse Practitioner - Family in Maple Grove, MN
About Henry Momanyi NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
HENRY MOMANYI (NPI 1679207013) is an individual family provider in Maple Grove, Minnesota, licensed in Minnesota (9297) and active in the NPI registry since July 2022. He is enrolled in Medicare PECOS and is a graduate of Other (2021).
NPPES Registry Identity
Specialties & Licenses
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Henry Momanyi is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignment
Medicare enrollment records show Henry Momanyi reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Maple Grove, MN 55369
- Reassigned Medicare billing, Minnesota enrollment
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 55369 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Other Providers at the Same Location NPPES
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
MAPLE GROVE, MN 55369
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Henry Momanyi's NPI number?
The NPI number for Henry Momanyi is 1679207013. It was assigned to this individual provider in the NPPES registry on July 12, 2022.
Where is Henry Momanyi located?
Henry Momanyi practices at 6773 Deerwood Ln N, Maple Grove, MN 55369. The listed phone number is (612) 598-8555.
What is Henry Momanyi's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.
Is Henry Momanyi enrolled in Medicare?
Yes. Henry Momanyi is registered in the Medicare PECOS enrollment system.
Which organization bills Medicare for Henry Momanyi's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Henry Momanyi reassigns Medicare benefits to Summit Advance Mobile Wound Care LLC (Maple Grove, MN). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Henry Momanyi's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
When was this NPI record last updated?
The NPPES record for Henry Momanyi was last updated on July 12, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Henry Momanyi · NPI 1679207013
Family physician in Maple Grove, Minnesota. Individual provider, active in the CMS NPPES registry since July 12, 2022.
## Identity
- **NPI:** 1679207013 (Entity type: Individual)
- **Enumerated:** July 12, 2022
- **Primary specialty:** Nurse Practitioner - Family · taxonomy 363LF0000X
- **State license:** 9297 (Minnesota)
- **Sole proprietor:** No
## Practice location
- **Address:** 6773 DEERWOOD LN N, Maple Grove, MN 55369-5530
- **Phone:** (612) 598-8555
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** Summit Advance Mobile Wound Care LLC (NPI 1316759566, Maple Grove, MN), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2021
## Record status
- **NPPES last updated:** July 12, 2022
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Source: [NPI Profile](https://npiprofile.com/npi/1679207013) · Data from the CMS NPPES public registry.